RESUMEN
The concept of cognitive reserve (CR) has been proposed to account for observed discrepancies between pathology and its clinical manifestation due to underlying differences in brain structure and function. In 433 healthy older adults participating in the Tasmanian Healthy Brain Project, we investigated whether common polymorphic variations in apolipoprotein E (APOE) or brain-derived neurotrophic factor (BDNF) influenced the association between CR contributors and cognitive function in older adults. We show that BDNF Val66Met moderates the association between CR and executive function. CR accounted for 8.5% of the variance in executive function in BDNF Val homozygotes, but CR was a nonsignificant predictor in BDNF Met carriers. APOE polymorphisms were not linked to the influence of CR on cognitive function. This result implicates BDNF in having an important role in capacity for building or accessing CR.
Asunto(s)
Factor Neurotrófico Derivado del Encéfalo/genética , Reserva Cognitiva , Función Ejecutiva , Anciano , Apolipoproteínas E/genética , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo GenéticoAsunto(s)
Cefalea/psicología , Trastornos Migrañosos/psicología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Psicofisiología , Factores SocioeconómicosRESUMEN
Physician behavior during inpatient rounds was observed and quantified for 394 interactions between patients with cancer and physicians. Most patients had solid tumors (90%) and a limited prognosis despite treatment (61%). The physicians spent 1.45 +/- 0.58 h on morning rounds seeing an average of 9.3 +/- 3.39 patients. For each patient an average of 3.61 +/- 2.83 min was spent in the room. The rest of the time was involved in reviewing the results of diagnostic tests, discussing treatment plans, and updating patient's charts. Time spent in the room was significantly related to the patient's sex and diagnosis. Physicians spent more time with patients having the poorest prognosis (p = 0.009). Specific behaviors were analyzed using a Physician Behavior Check List that allows accurate recording of behavior during a brief patients-physician encounter. Factor analysis of responses to the check list resulted in four factors that explained 58.7% of the variance. The physician behavior factor scores failed to correlate with factor scores from the responses of the same physicians to the Cancer Attitude Survey. In addition, the physicians were unable to accurately estimate the time they actually spent with patients or the frequency of specific behaviors that occurred during these interactions.
